HomeMy WebLinkAboutAge_Vessels (2) "o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
' PROPERTY TAX BENEFITS l
t )T State Form 43708(RI3/4-15) 3 s.Y\ F-'C-P 4„ �LQ
eu Prescribed by the Department of Local Government Finance CJ\ �"
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and riled or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessedes as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective. ylJ "—" c.
See reverse side for additional instructions and qualifications. 5
Typeof benefit requested q (please check all that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) nn
W S Ic \) tSe&S
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ID No
If name on record is ditfere t than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
FILED ❑ Yes ❑ No
Name of contract seller Hasa applicant owned or been bu
ying vying the property under recorded
contract for at least one(1)year befor claiming deduction?
APR 262019lYes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
TaxTY f>,UDITCIR / t
in distri 1 � L cnption Record number Page number
t \ . - 6--1Q-1.'-3 02-000 :319 -02 C
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
X 5182,430 for Over 65 Deduction or 5159,999(counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
❑ No � '�
-0 Have you filed for deductions in any other county. . If Yes,what county?
❑ Yes X No
1/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature plicant Address of applicant (num`bter and street,city,slat nd ZIP code),.., K- ch,,,,,,,G,J 564 N - AW- 1 i----ir cli —30-1-0-- 6 92 -
Signature ddf authorized representative Address of authorized representative (number and street,city,state,and ZIP code)